Risk of Cancer in a Community Exposed to Per- and Poly-Fluoroalkyl Substances.

BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) emissions from a plastic coating industrial source in southern New Hampshire (NH) have contaminated at least 65 square miles of drinking water. Prior research indicates that high levels of PFAS are associated with a variety of adverse health outcomes, including an increased risk of cancer. Reports indicate that mean blood serum levels of perfluorooctanoic acid (PFOA), one type of PFAS, in residents of the exposed community are more than 2 times greater than the mean blood serum level in the US. Merrimack public water supply customers also have higher average blood levels of perfluorooctane sulfonic acid (PFOS) and perfluorohexane sulfonic acid (PFHxS) than the time-matched US average. A 2018 report concludes that the incidence rate of cancer in Merrimack does not exceed the incidence rate of cancer in NH in general. However, prior reporting on the risk of cancer in Merrimack is compared only to a state-wide metric influenced by the Merrimack cancer incidence. METHODS: Our ecological study compared the risk in Merrimack, NH residents for 24 types of cancer between 2005 and 2014, targeted in a previous study, and all-cause cancers, to US national cancer rates and cancer rates in demographically similar towns in New England. Four New England "unexposed towns" were chosen based on demographic similarity to Merrimack, with no documented PFAS exposure in water supplies. We utilized unadjusted logistical regression to approximate risk ratios (RR) and 95% confidence intervals (CI) assessing the risk of cancer in Merrimack NH to each of the 4 comparator communities, the pooled comparator variable, and national average incidence. RESULTS: Residents of Merrimack, NH experienced a significantly higher risk of thyroid cancer (RR = 1.47, 95% CI 1.12-1.93), bladder cancer (RR = 1.45, 95% CI 1.17-1.81), esophageal cancer (RR = 1.71, 95% CI 1.1-2.65), and mesothelioma (RR = 2.41, 95% CI 1.09-5.34), compared to national averages. Our work also suggests that Merrimack residents experienced a significantly higher risk of all-cause cancer (RR = 1.34, 95% CI 1.25-1.43), thyroid cancer (RR = 1.69, 95% CI 1.19-2.39), colon cancer (RR = 1.27, 95% CI 1.02-1.57), and prostate cancer (RR = 1.36, 95% CI 1.15, 1.6) compared with similarly exposed New England communities. Our results indicate that residents of Merrimack may also have a significantly lower risk of some site-specific cancers compared to national averages, including lower risk of prostate cancer (RR = 0.57, 95% CI 0.5-0.66), female breast cancer (RR = 0.60, 95% CI 0.52-0.68), ovarian cancer (RR = 0.52, 95% CI 0.33-0.84) and cervical cancer (RR = 0.29, 95% CI 0.12-0.69). CONCLUSION: Merrimack residents experienced a significantly higher risk of at least 4 types of cancer over 10 years between 2005 and 2014. Merrimack is a community with documented PFAS contamination of drinking water in public and private water sources. Results indicate that further research is warranted to elucidate if southern NH residents experience increased risk for various types of cancer due to exposure to PFAS contamination.

Stress and Anxiety are Associated with Lower Gestational Weight Gain in Hispanic Women.

OBJECTIVE: Prior studies indicate that inadequate and excessive gestational weight gain (GWG) are associated with poor maternal and infant outcomes, and that stress and anxiety may contribute to GWG. However, these studies often failed to use validated measures of stress and anxiety, measured only total GWG, and were limited to largely non-Hispanic White populations. We explored the association between stress and anxiety and GWG. METHODS: We used data from 1,308 participants in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women 18-40 years of age (2006-2012). We measured stress with the Perceived Stress Scale and anxiety with the State-Trait Anxiety Scale, and abstracted GWG from medical records. RESULTS: The average GWG was 31.0 ± 16.1 pounds. More than one-half of participants (51.8%) exceeded Institute of Medicine guidelines for GWG. After adjusting for age and pre-pregnancy body mass index, women in the highest quartiles of stress and anxiety in early pregnancy had approximately 4 lbs lower GWG (ß = -3.89; SE = 1.54; p = .012 and ß = -4.37; SE = 1.54; p = .005, respectively) as compared with those in the lowest quartiles. Similarly, women in the highest quartiles of mid/late pregnancy stress and anxiety had lower GWG (ß = -3.84 lbs; SE = 1.39; p = .006, and ß = -3.51 lbs; SE = 1.38; p = .011, respectively) and a lower rate of GWG in the second and third trimesters (ß = -0.117 lbs/week; SE = 0.044; p = .008 and ß = -0.116 lbs/week; SE = 0.043; p = .007, respectively), compared with those in the lowest quartiles. CONCLUSIONS: High stress and anxiety were associated with lower GWG. Interventions to decrease stress and anxiety during pregnancy should include counseling on maintaining healthy GWG.

The Association Between Acculturation and Prenatal Psychosocial Stress Among Latinas.

Latinas experience high levels of stress in pregnancy, however few studies have investigated how acculturation affects pregnancy mental health among Latinas. The goal of this study was to determine if acculturation was associated with pregnancy stress among pregnant, predominantly Puerto Rican women. Participants (n = 1426) were enrolled in Proyecto Buena Salud, a prospective cohort study of Latinas. Acculturation on a bi-dimensional scale that allows for identification with both Latina and continental US cultures (i.e., bi-cultural vs. high or low acculturation) was measured in early pregnancy via the Psychological Acculturation Scale (PAS), language preference, and generation in the US. Stress was measured in early and mid/late pregnancy using Cohen's 14-item Perceived Stress Scale. After adjustment for risk factors, women with bicultural acculturation had significantly lower stress in overall pregnancy (ß = - 2.15, 95% CI - 3.5, - 0.81) and in mid/late pregnancy (ß = - 2.35, 95% CI - 3.92, - 0.77) as compared to women with low acculturation. There were no significant associations between proxies of acculturation (i.e., language preference and generation) and stress. Bicultural psychological acculturation was associated with lower stress in pregnancy, while proxies of acculturation were not. Bi-dimensional measures of psychological acculturation should be considered in future studies of maternal mental health.

Physical Activity and Risk of Cesarean Delivery in Hispanic Women.

BACKGROUND: Rates of cesarean delivery continue to increase among Hispanics, the largest minority group in the United States. Prior studies of the relationship between physical activity and cesarean delivery have been conflicting, limited by questionnaires not validated for pregnancy, and conducted primarily among non-Hispanic whites. METHODS: We evaluated this association among participants (n = 1313) in Proyecto Buena Salud, a prospective cohort of Hispanic women conducted from 2006 to 2011. Physical activity was measured via the Pregnancy Physical Activity Questionnaire. RESULTS: In total, 320 (24.4%) participants delivered via cesarean. In multivariable analyses, increasing levels of sedentary activity in mid/late pregnancy were associated with higher odds of cesarean delivery (odds ratio = 1.54; 95% confidence interval, 1.02-3.33; Ptrend = .05); however, there were no clear patterns between physical activity and cesarean delivery. When we repeated the analysis excluding planned cesarean deliveries (n = 126), high levels of prepregnancy moderate-intensity physical activity (odds ratio = 0.61; 95% confidence interval, 0.38-0.99) and increasing moderate-intensity physical activity in mid/late pregnancy (Ptrend = .03) were associated with reduction in odds. Increasing levels of household/caregiving physical activity in pre and mid/late pregnancy were associated with a 50% reduction in odds (Ptrend < .05). CONCLUSIONS: In this prospective cohort of Hispanics, sedentary activity increased odds of cesarean delivery, and moderate-intensity and household/caregiving physical activity reduced odds of unplanned cesarean deliveries.

Prepregnancy Body Mass Index, Gestational Weight Gain, and Odds of Cesarean Delivery in Hispanic Women.

OBJECTIVE: This study aimed to evaluate the association between prepregnancy body mass index (BMI), gestational weight gain (GWG), and cesarean delivery in Hispanics. METHODS: We examined these associations among 1,215 participants in Proyecto Buena Salud, a prospective cohort of Hispanic women studied from 2006 to 2011. Prepregnancy BMI, GWG, and the mode of delivery were abstracted from medical records. RESULTS: A quarter of the participants entered pregnancy with obesity, 23% delivered via cesarean, and 52% exceeded the Institute of Medicine guidelines for GWG. After adjusting for age, women with obesity had 2.03 times the odds of cesarean delivery compared with women with normal BMI (95% confidence interval [CI]: 1.46-2.82); findings remained significant after adjusting for GWG. Women with excessive total GWG had 1.49 times the odds of cesarean delivery (95% CI: 1.06-2.10) compared with women who gained within guidelines. An excessive rate of third trimester GWG (standard deviation [SD] change in GWG per week) increased the odds of cesarean delivery (odds ratio = 1.66; 95% CI: 1.05-2.62), while an excessive rate of first and third trimester GWG was not associated with increased odds. CONCLUSIONS: Obesity prior to pregnancy was associated with increased odds of cesarean delivery among Hispanics. Excessive GWG across pregnancy and an excessive rate of third trimester GWG were also associated with increased odds.